Overview of Standard Therapy of Muscle-Invasive Bladder Cancer

Treatment of muscle-invasive and metastatic bladder cancer requires a multidisciplinary approach, in which the urologist, radiation oncologist, and medical oncologist closely work together and counsel the patient to determine the most appropriate treatment. The main components of treatment are surgical resection, radiotherapy, and systemic therapy, traditionally involving chemotherapy. In recent years, major advances have been made in the treatment of bladder cancer, particularly in systemic treatment. New treatment modalities include immune checkpoint inhibitors, antibody-drug conjugates, and targeted therapy. While these advancements have primarily been applied to the treatment of advanced urothelial cancer, it is likely that these novel treatments will enter the nonmetastatic bladder cancer space. Additionally, bladder-preserving therapy has gained attention and is a frequent wish of patients, given the major impact of removal of the bladder on quality of life. These new developments will require even better multidisciplinary collaboration by the specialists involved in bladder cancer treatment and will hopefully lead to significant improvements in survival and quality of life for patients with bladder cancer.